• HPI: 6A 12 year-old boy comes to a local ER with complaints of sudden onset of severe headache for two days. Since that time he has had a dull headache and neck stiffness and no other symptoms. The ER physician does a lumbar puncture and frank blood is seen. A CT Head without contrast is completed and shows hyperdensity consistent with blood products in the posterior fossa. The patient is subsequently transferred to a tertiary care center. 

    PMH: 
    none 

    Allergies: 
    none 

    Medications: 
    none 

    Social History: 
    unremarkable 

    Neurological Exam: 
    normal 

    Figure 1. CT head without contrast:

    Figure 2. T1 axial MRI with contrast

    Figure 3. Digital Subtraction Angiogram, Right ICA.

    Figure 4. Digital Subtraction Angiogram, Left ICA.

    1. What is your diagnosis?

    2. What are your treatment recommendations?

    3. What kind of imaging follow-up would you recommend?

    4. What timeframe would you suggest follow-up?

    5. Would you put the patient on anti-epileptic medications?

    6. Please add any suggestions or comments regarding this case:

    • Unpredictable clinical course. Risks of rebleed are high.Not amenable to any form of treatment.
    • The posterior circulation angiogram and a venogram has not been demonstrated on these films.
    • for radiological investigations in the future its important to use most informative study according to facilities available .. I prefer CTA after first step of embolization zuhair hawawi resident

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